backflow prevention test report - british columbia
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Backflow Prevention Test ReportTelephone: (604) 660-1808 Fax: (604)
660-1874 E-mail: [email protected]
UNIVERSITY ENDOWMENT LANDS BACKFLOW PREVENTION ASSEMBLY TEST REPORT
THIS TEST REPORT MUST BE SUBMITTED WITHIN 14 DAYS Return completed to 5495 Chancellor Boulevard, Vancouver, BC V6T 1E2 or [email protected]
Property Owner/Business Name: Assembly Status W/ NEW SERVICE – Plumbing Permit #: __________
EXISTING REPLACEMENT – Prev. Device Serial No. _________ REMOVED & SERVICE CAPPED
Civic Address: Including street suffix – Ave., Cr., Wy., etc. Service Type BOILER FIRE SUPPRESSION IRRIGATION POOL
OTHER: Specify ____________________ Assembly Location: Specify Type of Assembly RPBA DCVA PVBA RPDA DCDA AG
Assembly Make Model Testing Equipment Test/Service Date Retest?* DIFF DUP S.T. Serial No. Size Line Pressure at Time of Test YYYY / MM / DD Check, if retest
inch psi *Existing devices tested after September 30th of each year require retesting the following Spring.
REDUCED PRESSURE ASSEMBLIES PRESSURE VACUUM BREAKER DOUBLE CHECK ASSEMBLIES 1st Check (A) 2nd Check Relief Valve (B) Buffer (C)
(A - B = C) Air Inlet Check Valve
Initial Test
DC CLOSED TIGHT CLOSED TIGHT OPENED AT OPENED AT PRESSURE DROP
RP ACTUAL PRESSURE DROP psid psid psid psid psid DID NOT OPEN LEAKED CONFIRMATION TEST? YES NO PASSED
FAILED
Test After Repair
DC CLOSED TIGHT CLOSED TIGHT OPENED AT OPENED AT PRESSURE DROP
RP ACTUAL PRESSURE DROP psid psid psid psid psid CONFIRMATION TEST? YES NO
LEAKED
Air Gap Inspection: Required minimum air gap separation provided? YES NO
Tester Name: First & Last BCWWA Certification No.: Testing Company: Address: Including Postal Code Phone: E-mail Address:
I certify that I have tested the above assembly and that it meets the performance requirements outlined in the Province of British Columbia Plumbing Code, latest edition.
Tester Signature ______________________________ Owner/Operator Signature ______________________________
Ministry of Municipal Affairs University Endowment Lands 5495 Chancellor Boulevard Vancouver, BC V6T 1E2
Telephone: (604) 660-1808 Fax: (604) 660-1874 E-mail: [email protected]
BACKFLOW PREVENTION PROGRAM
The following streets are in the UEL:
Acadia Road Kings Road Toronto Road Adelaide Road Kingston Road University Boulevard (5185 to 5885 only) Agronomy Road (5725 only) Knox Road Wesbrook Crescent Allison Road McMaster Road Western Crescent Campus Road Marine Drive, NW (5500 to 6000 only) Wesbrook Mall (Even # only, to 2280) Chancellor Blvd. (4700 to 5749) Newton Crescent Western Parkway (1630 to 2388) Chancellor Blvd. (5907 to 6087, odd # only) Newton Wynd Wycliffe Road College Highroad Queensland Road West 6th Avenue (4700 Block only) Dalhousie Road Tasmania Crescent West 7th Avenue (4700 Block only)
Backflow test reports for properties located on these streets should be forwarded to University Endowment Lands, 5495 Chancellor Boulevard, Vancouver, BC V6T 1E2 They can also be e-mailed to [email protected]
UNIVERSITY OF BRITISH COLUMBIA (UBC)
The following streets are in UBC:
Acadia Park Lane Hawthorn Lane President’s Row Agricultural Road Health Science Mall Revelstoke Court
Agronomy Road (Except 5725) Hospital Lane Ross Drive Applied Science Lane Imperial Road Salmo Court Berton Avenue Iona Drive Shrum Lane Binning Road Keremeos Court South Campus Road Bio Science Road Larkin Drive Stadium Road Birney Road Logan Lane Stores Road Cecil Green Park Road Lower Mall Student Union Boulevard Chancellor Boulevard (5902 to 6098, even # only) Main Mall Tennis Crescent Chancellor Mews Main Mall Greenway Thames Court Crescent Road Marine Drive, NW (6100 +) Theology Mall Eagles Drive Marine Drive, SW Thunderbird Boulevard East Mall Melfa Court Thunderbird Crescent Education Road Memorial Road University Boulevard (5586 +) Engineering Lane Military Road Walter Gage Road Fairview Avenue Nurseries Road Webber Lane Fairview Place Osoyoos Crescent Wesbrook Mall (All odd #; & even # over 2280) Gray Avenue Oyama Court West Mall Hampton Place Pearkes Lane Yalta Place
Backflow test results for properties located on these streets should be forwarded to Erin Kastner, UBC Energy & Water Services, 6130 Agronomy Rd, Vancouver, BC V6T 1Z3 via Maintenance Tracking Systems Inc. (MTS) at https://www.fastbfp.ca.
For any questions regarding UBC’s backflow testing program, please contact MTS at 250-503-0893 or [email protected]
April 2021
Property OwnerBusiness Name:
EXISTING: Off
BOILER: Off
RP ACTUAL PRESSURE DROP:
RP ACTUAL PRESSURE DROP':
CONFIRMATION TEST YES: Off
CONFIRMATION TEST NO: Off
CONFIRMATION TEST' NO: Off
CONFIRMATION TEST' YES: Off
BUFFER:
BUFFER':
2ND CHECK LEAKED: Off
1ST CHECK LEAKED: Off
1ST CHECK LEAKED': Off
RELIEF VALVE OPENED AT:
RELIEF VALVE OPENED AT':
Air Gap Inspection: YES
UNIVERSITY ENDOWMENT LANDS BACKFLOW PREVENTION ASSEMBLY TEST REPORT
THIS TEST REPORT MUST BE SUBMITTED WITHIN 14 DAYS Return completed to 5495 Chancellor Boulevard, Vancouver, BC V6T 1E2 or [email protected]
Property Owner/Business Name: Assembly Status W/ NEW SERVICE – Plumbing Permit #: __________
EXISTING REPLACEMENT – Prev. Device Serial No. _________ REMOVED & SERVICE CAPPED
Civic Address: Including street suffix – Ave., Cr., Wy., etc. Service Type BOILER FIRE SUPPRESSION IRRIGATION POOL
OTHER: Specify ____________________ Assembly Location: Specify Type of Assembly RPBA DCVA PVBA RPDA DCDA AG
Assembly Make Model Testing Equipment Test/Service Date Retest?* DIFF DUP S.T. Serial No. Size Line Pressure at Time of Test YYYY / MM / DD Check, if retest
inch psi *Existing devices tested after September 30th of each year require retesting the following Spring.
REDUCED PRESSURE ASSEMBLIES PRESSURE VACUUM BREAKER DOUBLE CHECK ASSEMBLIES 1st Check (A) 2nd Check Relief Valve (B) Buffer (C)
(A - B = C) Air Inlet Check Valve
Initial Test
DC CLOSED TIGHT CLOSED TIGHT OPENED AT OPENED AT PRESSURE DROP
RP ACTUAL PRESSURE DROP psid psid psid psid psid DID NOT OPEN LEAKED CONFIRMATION TEST? YES NO PASSED
FAILED
Test After Repair
DC CLOSED TIGHT CLOSED TIGHT OPENED AT OPENED AT PRESSURE DROP
RP ACTUAL PRESSURE DROP psid psid psid psid psid CONFIRMATION TEST? YES NO
LEAKED
Air Gap Inspection: Required minimum air gap separation provided? YES NO
Tester Name: First & Last BCWWA Certification No.: Testing Company: Address: Including Postal Code Phone: E-mail Address:
I certify that I have tested the above assembly and that it meets the performance requirements outlined in the Province of British Columbia Plumbing Code, latest edition.
Tester Signature ______________________________ Owner/Operator Signature ______________________________
Ministry of Municipal Affairs University Endowment Lands 5495 Chancellor Boulevard Vancouver, BC V6T 1E2
Telephone: (604) 660-1808 Fax: (604) 660-1874 E-mail: [email protected]
BACKFLOW PREVENTION PROGRAM
The following streets are in the UEL:
Acadia Road Kings Road Toronto Road Adelaide Road Kingston Road University Boulevard (5185 to 5885 only) Agronomy Road (5725 only) Knox Road Wesbrook Crescent Allison Road McMaster Road Western Crescent Campus Road Marine Drive, NW (5500 to 6000 only) Wesbrook Mall (Even # only, to 2280) Chancellor Blvd. (4700 to 5749) Newton Crescent Western Parkway (1630 to 2388) Chancellor Blvd. (5907 to 6087, odd # only) Newton Wynd Wycliffe Road College Highroad Queensland Road West 6th Avenue (4700 Block only) Dalhousie Road Tasmania Crescent West 7th Avenue (4700 Block only)
Backflow test reports for properties located on these streets should be forwarded to University Endowment Lands, 5495 Chancellor Boulevard, Vancouver, BC V6T 1E2 They can also be e-mailed to [email protected]
UNIVERSITY OF BRITISH COLUMBIA (UBC)
The following streets are in UBC:
Acadia Park Lane Hawthorn Lane President’s Row Agricultural Road Health Science Mall Revelstoke Court
Agronomy Road (Except 5725) Hospital Lane Ross Drive Applied Science Lane Imperial Road Salmo Court Berton Avenue Iona Drive Shrum Lane Binning Road Keremeos Court South Campus Road Bio Science Road Larkin Drive Stadium Road Birney Road Logan Lane Stores Road Cecil Green Park Road Lower Mall Student Union Boulevard Chancellor Boulevard (5902 to 6098, even # only) Main Mall Tennis Crescent Chancellor Mews Main Mall Greenway Thames Court Crescent Road Marine Drive, NW (6100 +) Theology Mall Eagles Drive Marine Drive, SW Thunderbird Boulevard East Mall Melfa Court Thunderbird Crescent Education Road Memorial Road University Boulevard (5586 +) Engineering Lane Military Road Walter Gage Road Fairview Avenue Nurseries Road Webber Lane Fairview Place Osoyoos Crescent Wesbrook Mall (All odd #; & even # over 2280) Gray Avenue Oyama Court West Mall Hampton Place Pearkes Lane Yalta Place
Backflow test results for properties located on these streets should be forwarded to Erin Kastner, UBC Energy & Water Services, 6130 Agronomy Rd, Vancouver, BC V6T 1Z3 via Maintenance Tracking Systems Inc. (MTS) at https://www.fastbfp.ca.
For any questions regarding UBC’s backflow testing program, please contact MTS at 250-503-0893 or [email protected]
April 2021
Property OwnerBusiness Name:
EXISTING: Off
BOILER: Off
RP ACTUAL PRESSURE DROP:
RP ACTUAL PRESSURE DROP':
CONFIRMATION TEST YES: Off
CONFIRMATION TEST NO: Off
CONFIRMATION TEST' NO: Off
CONFIRMATION TEST' YES: Off
BUFFER:
BUFFER':
2ND CHECK LEAKED: Off
1ST CHECK LEAKED: Off
1ST CHECK LEAKED': Off
RELIEF VALVE OPENED AT:
RELIEF VALVE OPENED AT':
Air Gap Inspection: YES